Covered Entity Details

CAH241346-00 CANNON FALLS MEDICAL CENTER - MAYO (Active) - information as of 4/25/2025 6:36:27 PM

Main Details

Name

CANNON FALLS MEDICAL CENTER - MAYO

Subdivision Name

Type

Critical Access Hospital

Rural

340B ID

CAH241346-00

Medicare Provider Number

241346

Additional Details

Current Program Status

Active

Registration Date

1/10/2017

Participating Start Date

4/1/2017

Participating Approval Date

2/17/2017

Last Recertification Date

8/14/2024

Contacts

Authorizing Official

Mayo Clinic
Travis C. Paul, Regional Chair of Administration SWMN
(608) 392-9716

Primary Contact

Mayo Clinic Health System
Matt Lemin, Program Manager
(507) 293-3853

Addresses

Street Address

32021 COUNTY 24 BOULEVARD
CANNON FALLS, MN 55009

Billing Address
Same as Street Address

Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
History

Comments

Comment	Last Updated On
No records to display.

Medicaid Billing

At this site, will the covered entity bill Medicaid fee-for-service for drugs purchased at 340B prices?
No

Shipping Addresses

Shipping Address 1

MCHS Cannon Falls Hospital Pharmacy
32021 County 24 Boulevard
1716
Cannon Falls, MN 55009

Shipping Address 2

MCHS Cannon Falls Outpatient Pharmacy
32021 County 24 Boulevard
1716
Cannon Falls, MN 55009

Contract Pharmacies

Contract Detail	Pharmacy Name	Address	Address Cont.	City	State	Zip Code	Approval Date	Begin Date	Last Updated On
Contract Detail	MAYO CLINIC PHARMACY	3551 Commercial Dr SW		Rochester	MN	55902	07/16/2024	10/01/2024	10/01/2024
Contract Detail	MAYO CLINIC PHARMACY CANNON FALLS	32021 COUNTY 24 BLVD	SUITE 1716	CANNON FALLS	MN	55009	07/13/2017	10/01/2017	10/01/2017
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 05081	4220 LEXINGTON AVE S	EAGAN	MN	55123	04/14/2023	07/01/2023	07/01/2023
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 06057	7135 E POINT DOUGLAS RD SOUTH	COTTAGE GROVE	MN	55016	04/14/2023	07/01/2023	07/01/2023
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 02496	14700 LAC LAVON DR	BURNSVILLE	MN	55306	04/14/2023	07/01/2023	07/01/2023
Contract Detail	WALGREEN CO.	DBA: WALGREENS #12404	3142 S SERVICE DR	RED WING	MN	55066	04/14/2023	07/01/2023	07/01/2023
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 02766	2010 CLIFF RD	EAGAN	MN	55122	04/14/2023	07/01/2023	07/01/2023
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 09727	14020 PILOT KNOB RD	APPLE VALLEY	MN	55124	04/14/2023	07/01/2023	07/01/2023
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 04038	15034 SHANNON PKWY	ROSEMOUNT	MN	55068	04/14/2023	07/01/2023	07/01/2023
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 09065	401 W 5TH STREET	NORTHFIELD	MN	55057	04/14/2023	07/01/2023	07/01/2023
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 07728	17630 KENWOOD TRAIL	LAKEVILLE	MN	55044	04/14/2023	07/01/2023	07/01/2023
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 05634	7560 160TH STREET WEST	LAKEVILLE	MN	55044	04/14/2023	07/01/2023	07/01/2023
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 01951	612 4TH ST NW	FARIBAULT	MN	55021-5035	04/14/2023	07/01/2023	07/01/2023
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 05048	1017 VERMILLION ST	HASTINGS	MN	55033	04/14/2023	07/01/2023	07/01/2023
Contract Detail	WALGREEN CO.	DBA: WALGREENS # 02661	15250 CEDAR AVE	APPLE VALLEY	MN	55124	04/14/2023	07/01/2023	07/01/2023

Parent/Child

340B ID	Hierarchy	Entity Type	Name	Sub Name	Address	City	State	340B Status
No records to display.

History

Section	Field	Action	Activity	Value Before	Value After	Timestamp
Contacts	Primary Contact	Update	Change Request	Buda, Alicia Operations Manager Mayo Clinic 5072933251	Lemin, Matt Program Manager Mayo Clinic Health System 5072933853	4/15/2025 8:24 AM
Contacts	Authorizing Official	Update	Change Request	Crockett, Eric Douglas Regional Chair-Administration Mayo Clinic 5074225678-5079909402	Paul, Travis C. Regional Chair of Administration SWMN Mayo Clinic 6083929716	12/17/2024 8:23 AM
Details	Last Recertification Date	Update	Recertification	8/22/2023 3:59:58 PM	8/14/2024 3:17:25 PM	8/14/2024 3:17 PM
Contacts	Authorizing Official	Update	Change Request	Johnson, Kristin S. Vice Chair Administration SE MN MayoClinic 5074349806	Crockett, Eric Douglas Regional Chair-Administration Mayo Clinic 5074225678-5079909402	5/2/2024 8:07 AM
Details	Last Recertification Date	Update	Recertification	9/1/2022 5:31:14 PM	8/22/2023 3:59:58 PM	8/22/2023 3:59 PM
Contacts	Authorizing Official	Update	Change Request	Gulden, Christopher Ryan Operations Administrator Mayo Clinic Health System Cannon Falls 6513456726	Johnson, Kristin S. Vice Chair Administration SE MN MayoClinic 5074349806	5/9/2023 8:26 AM
Details	Last Recertification Date	Update	Recertification	9/3/2021 1:43:22 PM	9/1/2022 5:31:14 PM	9/1/2022 5:31 PM
Contacts	Primary Contact	Update	Profile Change Request	Buda, Alicia M. E. Operations Manager Mayo Clinic 5072553648	Buda, Alicia Operations Manager Mayo Clinic 5072933251	12/21/2021 2:39 PM
Addresses	Shipping Address	Delete	Recertification	MCHS Cannon Falls Hospital Pharmacy 32021 County 24 Boulevard Ste 1716 Cannon Falls, MN 55009		9/3/2021 1:43 PM
Addresses	Shipping Address	Insert	Recertification		MCHS Cannon Falls Hospital Pharmacy 32021 County 24 Boulevard 1716 Cannon Falls, MN 55009	9/3/2021 1:43 PM
Addresses	Shipping Address	Insert	Recertification		MCHS Cannon Falls Outpatient Pharmacy 32021 County 24 Boulevard 1716 Cannon Falls, MN 55009	9/3/2021 1:43 PM
Contacts	Primary Contact	Update	Recertification	Christopherson, Darrin Senior Business Analyst-340B Midwest Programs Mayo Clinic 5072845035	Buda, Alicia M. E. Operations Manager Mayo Clinic 5072553648	9/3/2021 1:43 PM
Details	Last Recertification Date	Update	Recertification	9/10/2020 9:06:36 AM	9/3/2021 1:43:22 PM	9/3/2021 1:43 PM
Details	Last Recertification Date	Update	Recertification	9/5/2019 7:50:55 AM	9/10/2020 9:06:36 AM	9/10/2020 9:06 AM
Contacts	Authorizing Official	Update	Change Request	Priest, William CAO MCHS-Cannon Falls Mayo Clinic Health System - Cannon Falls 5072639700	Gulden, Christopher Ryan Operations Administrator Mayo Clinic Health System Cannon Falls 6513456726	8/14/2020 3:52 PM
Details	Last Recertification Date	Update	Recertification	8/21/2018 2:38:01 PM	9/5/2019 7:50:55 AM	9/5/2019 7:50 AM
Contacts	Primary Contact	Update	Change Request	Hovell, Jenni 340B Operations Manager Mayo Clinic 5072845061	Christopherson, Darrin Senior Business Analyst-340B Midwest Programs Mayo Clinic 5072845035	5/15/2019 11:04 AM
Addresses	Shipping Address	Insert	Change Request		MCHS Cannon Falls Hospital Pharmacy 32021 County 24 Boulevard Ste 1716 Cannon Falls, MN 55009	4/10/2019 7:24 AM
Details	Last Recertification Date	Update	Recertification	11/15/2017 12:47:52 PM	8/21/2018 2:38:01 PM	8/21/2018 2:38 PM
Details	Last Recertification Date	Update	Recertification		11/15/2017 12:47:52 PM	11/15/2017 12:47 PM
Contacts	Authorizing Official	Update		Priest, William CAO MCHS-Cannon Falls 5072639700	Priest, William CAO MCHS-Cannon Falls Mayo Clinic Health System - Cannon Falls 5072639700	10/25/2017 11:16 AM
Contacts	Signed By	Update		Priest, William CAO MCHS-Cannon Falls 5072639700	Priest, William CAO MCHS-Cannon Falls Mayo Clinic Health System - Cannon Falls 5072639700	10/25/2017 11:16 AM
Contacts	Primary Contact	Update		Hovell, Jenni 340B Operations Manager 5072845061	Hovell, Jenni 340B Operations Manager Mayo Clinic 5072845061	9/27/2017 5:15 PM
Addresses	Main Address	Insert			32021 COUNTY 24 BOULEVARD CANNON FALLS, MN 55009	8/14/2017 6:23 PM
Contacts	Primary Contact	Update		Berg, Tracy Asst Director 5075381203	Hovell, Jenni 340B Operations Manager 5072845061	8/14/2017 6:23 PM
Contacts	Authorizing Official	Insert			Priest, William CAO MCHS-Cannon Falls 5072639700	8/14/2017 6:23 PM
Contacts	Signed By	Insert			Priest, William CAO MCHS-Cannon Falls 5072639700	8/14/2017 6:23 PM
Contacts	Primary Contact	Insert			Berg, Tracy Asst Director 5075381203	2/22/2017 10:24 AM
Dates	Participating Approval Date	Update			2/17/2017 12:00:00 AM	2/17/2017 5:58 PM
Details	State	Update		Pending	Active	2/17/2017 5:58 PM
Dates	Start Date	Update			4/1/2017 12:00:00 AM	2/17/2017 5:58 PM
Details	340B ID	Update		ONLINE_REG_74355	CAH241346-00	2/2/2017 1:53 PM
Details	340B ID	Update			ONLINE_REG_74355	1/10/2017 2:20 PM
Details	Last Recertification Date	Insert				1/10/2017 2:20 PM
Details	Grant Number	Insert				1/10/2017 2:20 PM
Details	340B ID	Insert				1/10/2017 2:20 PM
Details	Is Authorizing Official EHB Data	Insert				1/10/2017 2:20 PM
Dates	Last Date That 340B Drugs Purchased	Insert				1/10/2017 2:20 PM
Details	Medicare Provider Number	Insert			241346	1/10/2017 2:20 PM
Details	Entity Name	Insert			CANNON FALLS MEDICAL CENTER - MAYO	1/10/2017 2:20 PM
Details	Program Code	Insert			CAH	1/10/2017 2:20 PM
Details	Entity Subname	Insert				1/10/2017 2:20 PM
Dates	Participating Approval Date	Insert				1/10/2017 2:20 PM
Details	State	Insert			Pending	1/10/2017 2:20 PM
Dates	Registration Date	Insert			1/10/2017 12:00:00 AM	1/10/2017 2:20 PM
Dates	Signed By Date	Insert			1/10/2017 12:00:00 AM	1/10/2017 2:20 PM
Dates	Start Date	Insert				1/10/2017 2:20 PM
Terminations	Termination Comments	Insert				1/10/2017 2:20 PM
Terminations	Termination Date	Insert				1/10/2017 2:20 PM
Terminations	Termination Effective Date	Insert				1/10/2017 2:20 PM
Terminations	Termination Reason	Insert				1/10/2017 2:20 PM